MH701 Final Exam Questions with 100% Correct Answers | Verified | Latest Update, Exams of Advanced Education

Download MH701 Final Exam Questions with 100% Correct Answers | Verified | Latest Update and more Exams Advanced Education in PDF only on Docsity! MH701 Final Exam Questions with 100% Correct Answers | Verified | Latest Update How is the amygdala part of the brain involved in anxiety? - Correct Answer-* Amygdala is in the center of the brain near the hippocampus. * The amygdala rates the importance of an emotional event and activates the hippocampus accordingly. * Determines whether there will be a fear response and initiates your flight or flight response that helps you respond to a perceived threat. * When this response remains switched on and there is no danger, or gets switched on too easily, that is when it becomes an anxiety disorder. Then you can have an initiation of the flight or fight when memories or emotions occur. * The amygdala sends a response to the hypothalamus, which activates the pituitary and it activates the adrenal gland which secretes hormones (adrenaline, noradrenaline and cortisol). What are neurotransmitters involved in depression? - Correct Answer-Monoamine neurotransmitters are responsible for depression which are: serotonin, norepinephrine & dopamine. Which neurotransmitters are associated with antipsychotics? - Correct Answer-The FGA's block dopamine. The SGA's block dopamine and 5HT. Some have affinity for histamine and alpha 1 adrenergic receptors. What is a common mistake leading to unsuccessful antidepressant drug trial? - Correct Answer-Not giving it enough time. Major depression is? - Correct Answer-5 or more of the following symptoms in the same 2 week period with at least 1 being depressed mood or loss of interest or pleasure. SIGECAPS S: Sleep changes. I: interest loss. G: Guilt or worthlessness. E: Energy lack. C: Concentration /cognition reduced. A: Appetite usually declined. P: Psychomotor retardation. * Taper over several weeks to minimize discontinuation symptoms Discontinuation syndrome: symptoms - Correct Answer-* Flu- like: Chills, body aches, nausea, headache, lightheadedness * Neurological symptoms : paresthesia's, insomnia, electro- shock like phenomena Sexual side effects of SSRI's and possible intervention: - Correct Answer-Women can be anorgasmic and men have erectile dysfunction. Bupropion (Wellbutrin) can reduce sexual side effects. Which SSRI has the highest risk of drug-drug interactions due to CYP enzymes? - Correct Answer-Most Problematic - Paroxetine, followed by fluoxetine - Significant effects on CYP2D6 Least Problematic - Sertraline, Citalopram, and Escitalopram Mechanism of action of TCA's: - Correct Answer-TCA's: Increase levels of NE and SE. They do this by interfering with reuptake of them at the synapse. However they also affect many other neurotransmitters, hence all the SE. What are the most concerning side effects of TCA's? - Correct Answer-Sedation, cardiac and anticholinergic. * Anticholinergic side-effects: dry mouth, constipation, blurred vision, urinary retention, delirium * Cardiac : tachycardia, arrhythmias, orthostatic hypotension More lethal in overdose - cardiac arrhythmias. Monitor blood levels to prevent cardiac toxicity * Sedation: increased SS risk Risks with patients being on a TCA? - Correct Answer-Cardiac arrhythmias which can be lethal Mechanism of action of MAOIs: - Correct Answer-Monoamine oxidase is originally responsible for inhibiting the action of norepinephrine, dopamine, and serotonin. Therefore blocking its action allows for more to be available in the body. These are JUST AS EFFECTIVE AS SSRI'S BUT HAVE MORE SERIOUS ADVERSE EFFECTS AND INTERACTIONS. Side effects you would be most concerned about with MAOIs: - Correct Answer-Hypertensive crisis. -Patient education that is important related to the MAOIs: - Correct Answer-Diet that avoids tyramine Sauerkraut, ETOH- beer and wine, cured meats, such as sausage, salami, pepperoni, hot dogs, bologna, smoke fish, pickled foods, figs, raisins, chocolate, yeast and aged cheeses . Drug -Drug interactions: MAOIs - Correct Answer-mixing with barbitutes, tricyclic antidepressants, antihistamines, CNS depressants, OTC cold meds, antihypertensives and SSRI/SNRI Serotonin Syndrome Risk with M AOIs: - Correct Answer- When switching from SSRI or SNRI risk of serotonin syndrome -complete taper and wash out before switching to MAOI Define GAD: - Correct Answer-excessive anxiety and worry about several events or activities for most days in at least a 6 month period. Worry is difficult to control and can be associated with somatic symptoms. Produces impairment in a person's life. Define Social anxiety: - Correct Answer-Involves the fear of social situations, including situations that involve scrutiny or contact with strangers. Clients are fearful of embarrassing themselves in social situations. Propranolol: beta blocker, blockade of beta 1 adrenergic receptors. Vistaril (Hydroxyzine): blockade of histamine receptors. General prescribing guidelines for benzodiazepines. - Correct Answer-* To be used for short periods of time, 1-2 weeks. If used for short periods then no concern of addiction. Short acting benzos, they may have some anxiety the day after. * Taper slowly as noted below. * Contraindicated in: pregnancy, lactation, hepatic disease, renal disease, children <6, acute narrow-angle glaucoma. Patient education for benzodiazepines. - Correct Answer-* Do not operate heavy machinery due to drowsiness * Elderly - increased risk of falls → fractures; also reduced hepatic clearance * Do not take with other sedatives, such as alcohol, which can cause sedation and respiratory depression and disinhibition. * Hepatic insufficiency can cause toxicity, including hepatic coma. * COPD and sleep apnea - can cause respiratory depression. * Pregnancy - teratogenic; secreted in breastmilk and can cause dyspnea, bradycardia and drowsiness in nursing infants. * Do not use in patients with hx of substance abuse * Caution in renal disease Risk of discontinuation of long-term use of a benzodiazepine is: - Correct Answer-* Go slowly and gradually. * Reduction of ~ 25% of the initial dose every 2 weeks OR decrease total daily dose by 25% the 1st week, another 25% the 2nd week, then 10% a week until discontinuation. * Moderate reductions at higher doses and smaller reductions at lower doses. * The specific dose reductions would vary as a function of patients'. * readiness to discontinue and the presence or absence of withdrawal symptoms. * Withdrawal symptoms Rebound anxiety, restlessness, tremor, sweating, agitation, insomnia. * Seizures when benzos are used greater than 8 weeks Define bipolar I: - Correct Answer-must meet criteria of manic episode which may be preceded by or followed by hypomanic or MDD; remember DIGFAST mnemonic for mania- Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness. Define bipolar II: - Correct Answer-must never have had manic episode and must have history of at least one hypomanic episode and one MD episode. Define cyclothymia: - Correct Answer-chronic (2 years-more than half the time) and fluctuating mood disturbance of hypomanic symptoms and depressive symptoms that does not meet criteria for MDD or hypomanic and never had episode of mania. Difference between hypomania and mania: - Correct Answer-- time: hypomania lasts at least 4 days (less than a week) while mania lasts longer than a week Which medications/classes of meds would be avoided with treatment of bipolar? - Correct Answer-Anti-depressants. Therapeutic levels of lithium: - Correct Answer-Bipolar and unipolar depression - 0.8-1.0 mEq/L Mania - 0.9-1.4 mEq/L N - Nephrotoxicity; it is metabolized by the kidney; causes acute kidney injury; chronic kidney disease (stay hydrated)-- increased concentration with NSAIDS or diuretics O - HypOthyroidism is a common complication of long term lithium use; obtain baseline TSH; may need treatment for thyroid hormone replacement P - Pregnancy--first 5 weeks; known teratogen; Ebstein's anomaly What would you do for your patient if they had any of the signs of lithium toxicity? (Mild, moderate or severe?) - Correct Answer-* Mild to moderate (1.5-2.0mEq/L): vomiting, abdominal pain, ataxia, dizziness, slurred speech, nystagmus, muscle weakness, probably thirsty * Moderate to severe (2.0-2.5mEq/L): anorexia, persistent N/V, blurred vision, clonic limb movements, hyperactive DTRs, convulsions, delirium, coma, stupor * Severe (>2.5mEq/L): convulsions, oliguria, renal failure, death * Levels >4.0mEq/L= hemodialysis If toxicity is suspected: Stop med and go to ED VS, Neuro check, Electrolytes, Renal fx, EKG Gastric lavage, activated charcoal, emesis Patient education that is important related to lithium - Correct Answer-Pregnancy - can lead to birth defects such as Epstein's Anomaly (low implanted tricuspid LIT) watch for? Salt intake, sweating , NSAIDs stay hydrated. Caffeine and ETOH What medication interactions would you educate your patient about when taking lithium (What meds could increase lithium levels leading to toxicity)? - Correct Answer-* Level (0.5-1.5) * NSAIDs, thiazide diuretics, ACE inhibitors can increase level * Monitor thyroid, renal function, electrolytes, EKG * Monitor sodium intake and hydration Lamotrigine - What significant patient education would you provide to a patient? - Correct Answer-Rash - common and potentially severe - discontinue med if it appears; can be a benign maculopapular rash within the first four months; even a benign rash can be a precursor to Stevens-Johnson syndrome or toxic epidermal necrolysis; discontinuation of med during severe hypersensitivity may not curb life- threatening rash; children under 16 yo are more susceptible to rash. Lamotrigine - What is important to know about dosing this medication? - Correct Answer-Start low and go slow to reduce risk of rash 25 mg/day for 2 weeks, then increase to 50 mg for 2 weeks (25 mg BID), then 100 mg for two weeks; typically no more than 200 mg/day Lamotrigine and valproic acid, how to dose: - Correct Answer- Valproic acid (Depakote) increases plasma levels of Lamictal Start with lower dose of 25 mg EOD for two weeks, then resume normal dosing; typically do not exceed 100 mg/day Lamotrigine and carbamazepine, how to dose. - Correct Answer-Carbamazepine LOWERS lamotrigine levels (so does phenytoin and phenobarb) Start at higher dose of 50 mg q day for 2 weeks, then 100 mg/day for 2 weeks with max dose of 400 mg/day Patients typically start at 25 mg BID and increase to 50 mg BID in one week. week, then raise based on response by 3 mg BID every week, max 24 mg BID. FGA SE: TX for dystonia: - Correct Answer-a. Duration to implement treatment: minutes to hours. b. Symptoms: laryngospasm, torticollis, oculogyric crisis. c. Treatment options: benztropine or other anticholinergic PO or IM. FGA se: Tx for pseudo parkinsonism - Correct Answer-a. Duration to implement treatment: Days b. Symptoms: rigidity, mask like face, cogwheel rigidity, perioral tremor, bradykinesia. c. Treatment options: Benztropine 1-2 mg 1-2 times a day FGA's SE: Tx for Akathisia: - Correct Answer-a. Duration to implement treatment: days to weeks. b. Symptoms: reversible c. Treatment options: benzodiazepine, beta blocker (propranolol 10 mg bid, can go up to 30-90 mg daily in 2-3 divided doses.) Neurotransmitters with SGA's - Correct Answer-Beyond antagonism of 5HT 2a & D23 receptors, atypical antipsychotics interact with multiple other subtypes for both dopamine and serotonin & have effects on other neurotransmitter systems as well. Side effects of SGA's: - Correct Answer-Weight gain, sedation, hyperprolactinemia, cardiac effects, EPS, akathisia. SGA MOA: - Correct Answer-Partial blocker of D2 and also blocks 5HT.. Lab work for SGAs - Correct Answer-CBC, LFT, EKG, BP, weight, BMI Which of the atypical antipsychotics has less sedating side effects? - Correct Answer-Lurasidone is the least sedating of all of the atypical antipsychotics. Generally speaking the "pines" are more sedating than the drones. Potent antihistamine actions: clozapine, quetiapine, olanzapine and iloperidone. Which of the atypical antipsychotics has less metabolic side effects? - Correct Answer-Low metabolic risk - Ziprasidone, aripiprazole, lurasidone, iloperidone (low for dyslipidemia) & anasapine. Neuroleptic Malignant syndrome—Symptoms & Treatment - Correct Answer-*A life threatening emergency and is fatal in 10% of cases. * Symptoms - reduced consciousness; increased muscle tone; autonomic dysfunction (hyperpyrexia, hypertension, tachycardia, tachypnea, diaphoresis & drooling). Can have cogwheeling (upper limbs with rigidity &* superimposed rhythmic contractions on passive ROM). * Treatment - early detection, discontinuation of the antipsychotic, management of temperature, and monitoring for complications. Extrapyramidal side effects-interventions for treating: - Correct Answer-Most common EPS sx are: akathisia (trouble standing still, paces floor, feet in constant motion), parkinsonism and dystonic reactions. If it develops, give benztropine (Cogentin) trihexyphenidyl, or diphenhydramine. Sx for opioid intoxication: - Correct Answer-altered mood, psychomotor retardation, drowsiness, slurred speech, impaired memory and attention Sx opioid withdrawal: - Correct Answer-dysphoric mood, n/v, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, insomnia Sx of Amphetamine intoxication - Correct Answer-mydriasis, psychomotor agitation or retardation, tachycardia or bradycardia, perspiration or chills, cardiac arrhythmias or chest pain, elevated or lowered BP, dyskinesias, dystonias, weight loss, N/V, muscular weakness, respiratory depression, confusion, seizures or coma Sx of amphetamine withdrawal - Correct Answer-anxiety, tremulousness, dysphoric mood, lethargy, fatigue, nightmares, headache, profuse sweating, muscle cramps, stomach cramps, insatiable hunger sx of hallucinogen intoxication - Correct Answer-maladaptive behavior and perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremors, incoordination Sx benzodiazepine intoxication: - Correct Answer- Incoordination, disinhibition, less euphoria, dysarthria, nystagmus impaired memory and gait->stupor, coma and death Sx of benzo withdrawal? - Correct Answer-light and loud noise sensitivity, nausea, sweating, muscle, twitching and seizure *per Stahl s generally seizures are seen after cessation of large a doses >/=50 mg a day What is the reason for Naloxone being added to the Suboxone? - Correct Answer-Prevents misuse of drug by crushing or injecting- naloxone is poorly absorbed via sublingual but if used other routes it is absorbed as a mu- opioid antagonist that prevents overdose- preferred due to SAFETY factor Which benzos are most commonly used to treat alcohol withdrawal? - Correct Answer-Long acting either chlordiazepoxide or diazepam Short acting is lorazepam Wernicke's encephalopathy-How is this identified & What is the treatment ? - Correct Answer-Characterized by decreased in mental functioning, paralysis or weakness in one or more muscles, ataxia (unsteady gait), nystagmus, and mental status changes (confusion, apathy, difficulty concentrating) in a person who abuses alcohol Thiamine deficiency so must treat with oral or IV thiamine. Oral w/ food 100mg 3x per day or IV 100 mg in 1L of fluid with glucose. Reversible and should be treated before turning into korsakoff syndrome which is nearly irreversible -Patient education about disulfiram (interaction with alcohol containing product) - Correct Answer-* Dangerous side effect occur if you drink alcohol including flushing, tachycardia, n/v, headache, CP, difficulty breathing * These symptoms can occur within 10 minutes after drinking even a small amount of alcohol (including OTC medicine like cough syrup that has ETOH in it) and can last for an hour or more * You should not take disulfiram less than 12 hours after consuming ETOH or you may experience same symptoms ADHD inattentive type - Correct Answer-ADHD in which inattention is the main problem. 4. Irritability - monitor timing of symptom, reduce dose, consider alternative 5. Dysphoria, Irritability - consider comorbid dx, reduce dose or change to long acting, consider adjuvant tx 6. Less common - tics, dyskinesias, movement disorders Non-stimulants for ADHD - Correct Answer-atomoxetine (Strattera) clonidine (Catapres) guanfacine (Tenex) Bupropiion Atomoxetine (Strattera): MOA - Correct Answer-Selective inhibitor of norepinephrine reuptake Bupropion MOA: - Correct Answer-a. NE DA reuptake inhibitor (NDRI). What are the 2 alpha adrenergic agonists used for ADHD? - Correct Answer-Clonidine (Catapres) Guanfacine (Tenex) Mechanism unknown Which are the first line antidepressants for children? - Correct Answer-Fluoxetine, sertraline and citalopram. Escitalopram is over 12. What are the first line medications for anxiety for children? - Correct Answer-Fluvoxamine, fluoxetine, sertraline & paroxetine. Define postpartum blues: - Correct Answer-a transient mood disturbance characterized by mood lability, sadness, dysphoria, subjective confusion and tearfulness. May last several days. No treatment except education & support. Define postpartum depression - Correct Answer-Onset within 12 weeks from delivery. Depressed mood, excessive anxiety, insomnia (her lecture says change in weight, but everyone has that after a baby is born??) If signs of baby blues above persists for more than 2 weeks, then evaluate for PP depression. Define postpartum psychosis - Correct Answer-Depression, delusions, thoughts of harming self or infant. Usually begins within days of delivery (mean is 2-3 weeks). Have some of the same signs of depression, fatigue, insomnia, restlessness, & tearfulness. Later they get suspicious, have confusion, incoherence irrational statements, & obsessive concerns., Which antidepressants, mood stabilizers, or antipsychotic medications are safe in pregnancy? (Are any safe in Pregnancy?) - Correct Answer-Antidepressants - Sertraline is the first choice. Paroxetine is not used. Bipolar: Lamotrigine is used for bipolar maintenance, has protective effects against bipolar depression and a growing reproductive safety profile Antipsychotics - Lurasidone (Latuda) is a class B. What education would you provide to a patient about the adverse effects for antidepressants to a patient who is pregnant? - Correct Answer-Risk versus benefits of any of these medications is taken into consideration. Antidepressants are the most studied in pregnancy. Exposure to SSRI's in the third trimester are associated with poor neonatal adaptation with sx of transient neonatal complications. There are conflicting reports of pulmonary hypertension in newborns with mother's taking SSRI's. Patients also need to know that the relapse of depression in pregnancy is high. Cyclosporine, which prevents the body from rejecting transplanted organs Some heart medications, including digoxin and ivabradine Some HIV drugs, including indinavir and nevirapine Some cancer medications, including irinotecan and imatinib Warfarin, an anticoagulant (blood thinner) Certain statins, including simvastatin. What are the effects of St Johns Wort and antidepressants? - Correct Answer-Taking St. John's wort with certain antidepressants or other drugs that affect serotonin, a substance produced by nerve cells, may lead to increased serotonin-related side effects, which may be potentially serious. St. John's Wort & pregnancy: - Correct Answer-It may not be safe to use St. John's wort during pregnancy or while breastfeeding. It has caused birth defects in laboratory animals. Breastfeeding infants of mothers who take St. John's wort can experience colic, drowsiness, and fussiness. SE of St. John's Wort - Correct Answer-St. John's wort may cause increased sensitivity to sunlight, especially when taken in large doses. Other side effects can include insomnia, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction. What patient education would you provide about St. John's wort to your patient? - Correct Answer-Many drug interactions- talk with provider before trying this supplement Do not take with SSRIs- increases risk of serotonin syndrome Only evidence for use is in mild to moderate depression Do not take during pregnancy or breastfeeding Side effects - light sensitivity, insomnia, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction. Gingko Biloba use - Correct Answer-Anxiety, dementia, PMS, Schizophrenia, stroke, TD, Vertigo Lack of evidence for antidepressant-induced sexual dysfunction, CVD, chemo related cognitive decline, hypertension, MS, tinnitus Ginkgo biloba education: - Correct Answer-Many drug interactions Most common side effects are: Dizziness, gastrointestinal symptoms, headache. Serious Adverse Effects (Rare): Arrhythmia, bleeding, Stevens- Johnson syndrome. Could increase bleeding time, increased blood sugar Unsafe in pregnancy → induce labor Ginseng Use: - Correct Answer-Stimulant for fatigue, elevation of mood, and improve immune system Ginseng education - Correct Answer-Safe dose up to 1-2 g of root 3-4 times per day, max 3-4 weeks Do not use with sedatives, hypnotics, MAOIs, antidiabetic agents, or steroids Side effects - insomnia, hypertonia and edema; headaches Do not use if you have low blood glucose, high BP or CV problems Melatonin (N-acetyl-5-methoxytrptamine) use: - Correct Answer-What - hormone produced mainly at night in the pineal gland; can be taken exogenously to help promote somnolence liver. It is also an antioxidant, so it may play a role in preventing cancer. Some research shows it may help aggression in autism. Used for swelling in the airway; COPD; to present kidney damage; and lung disease that leads to scarring. Patient education that would be important regarding N- acetylcysteine: - Correct Answer-Likely safe in children and pregnancy. Concern that it may cause bronchospasm in asthma. Might slow blood clotting in someone who already has a clotting disorder. Should be stopped 2 weeks prior to surgery because of the slowed clotting. Interacts with nitroglycerine. Memantine (Namenda) - Correct Answer-a type of NMDA antagonist, is to reduce abnormal activation of glutamate neurotransmission and thus interfere with the pathophysiology of Alzheimer's disease, improve cognitive function, and slow the rate of decline over time. Used for moderate to severe dementia and in adjunct with a cholinesterase inhibitor. Donepezil (Aricept) - Correct Answer-cholinesterase inhibitor Treats behavioral and psychological sx of Alzheimer's as well as cognitive. Inhibits AChE, increasing availability to ACh. Galantamine (Razadyne®): - Correct Answer-approved for mild-to-moderate stages of Alzheimer's disease; dual action and modulates nicotinic receptors and enhances the action acetylcholine.